Junior Hospital Doctors Judicial Review and new strikes

BMA press release

The BMA is now set to launch a judicial review following the embarrassing revelation that the government appears to have failed to undertake an Equality Impact Assessment (EIA) prior to its decision to impose a new contract on junior doctors in England. In trying to push through these changes, sildenafil the government failed to give proper consideration to the impact this contract could have on junior doctors.

The judicial review will seek to overturn the decision to impose the new contract and provide a declaration that the secretary of state has acted unlawfully.

Imposing this contract will seriously undermine the ability of the NHS to recruit and retain junior doctors in areas of medicine with the most unsocial hours, cialis where there are already staffing shortages.

 

As a result, sovaldi sale there will be three further dates of industrial action:

  • 9 - 11 March 2016
    Emergency care only between 8am on Wednesday 9 March and 8am on Friday 11 March (48 hours)
  • 6 - 8 April 2016
    Emergency care only between 8am on Wednesday 6 April and 8am on Friday 8 April (48 hours)
  • 26 - 28 April 2016
    Emergency care only between 8am on Tuesday 26 April and 8am on Thursday 28 April (48 hours)

Jeremy Hunt's vision of the future of the NHS: speech to the Health Service Journal on Thursday 29th October 2015

 

In his speech on Thursday 29th October to the Health Service Journal  Jeremy Hunt provides his vision of the NHS of the future. It is an important speech, physician well constructed and covering both technical and human factors.

Jeremy Hunt frames the discussion in terms of a "learning culture", remedy avoiding the "elephant traps" of poor organisation in hospitals. Of course everyone will endorse this goal. But there is no mention of additional money to hire extra permanent staff and reduce pressure all around. He lists the existing and very-nearly-developed devices and data banks which could greatly reduce the work of nurses and GPs in monitoring and controlling chronic conditions.

He mentions new electronic gadgets such as Fitbit and Jawbone (fitness monitoring - with weight monitoring thrown in). He mentions the possibility of measuring, from a single drop of blood, the levels of 300,000 "markers" which can then be fed into a database and will return, possibly after several iterations over a period of weeks, a single diagnosis. He mentions pills into which are embedded a minute chip which is activated by bile acid in the gut, and which thus monitor directly whether the patient is or is not taking his medication. And he mentions patients' medical records being uploaded onto a central database....

It sounds like a brave new world: the patient is being constantly measured and monitored. His mere continued existence - provided that he wears the Fitbit bracelet and provides the drop of blood into a machine when requested - will ensure that the computer has up-to-date results and will alert the patient if anything is going wrong.


What could possibly go wrong?


Answer: the "care" is remote and inhuman! At some point the patient may well feel that he is being "hounded" to comply, not invited to keep himself well. Or he eventually may suspect conditions where "The computer says "NO"" to medical treatment. Constant monitoring using smart phones is also a very serious breach of the patient's privacy (GPS tracking makes your position available in real time) And the computer's reference limits for conditions which are expensive to treat could perhaps be "doctored" in future.


As for keeping our medical records safe.... I do not trust the NHS to stop the data leaking to insurance companies. Insurance companies know the data exists, they want it, they will find a way to get it! And then people with serious medical conditions will find it impossible to get motor or travel insurance, to say nothing of medical insurance, etc....

 

 

The mega tender for cancer and end-of-life care: Staffordshire in March 2015

Open Democracy Our NHS's Caroline Malloy has written "Leak reveals worrying truth behind the biggest NHS privatisation yet" (March 2015)".

Keys parts:

The leaked proposals include handing all responsibility for commissioning cancer services for 800, sales 000 patients to a ‘prime provider’ - which can be a private company - who will then sub-contract services to companies of their choice, after an initial 2-year handover period. The first tranche of patients to be handed over to new companies will be breast, lung, bladder and prostate cancer, with others added later, we learn today.

The most worrying thing about the leaked plans is their lack of accountability or redress and their shocking vagueness.

The document sets out “The commissioners do not intend to specify in detail how outcomes should be achieved” preferring instead “the use of high level outcomes”. It sets out how the contract will be based on nine outcomes set out by Macmillan such as “I can enjoy life” and “I want to die well”.

During the first two years the main responsibility on the company will be to develop a more detailed set of ‘service outcomes’ - the criteria that they will be measured against for the remaining eight years.

This, Godfrey [Parliamentary Labour candidate Kate Godfrey] says, is a unique arrangement - deciding ‘most of elements of contract design’ such as performance standards and targets, after the contract has been awarded. The company writes its own rules, effectively, and decides what it will - and won't - do.

But there are clues. There is an emphasis on patients being expected to “self-manage at home”. There is talk of a “stable and managed change environment where providers of care know what is expected of them…this will require disinvestment for (some)”.

Experienced health campaigner John Lister of Health Emergency has described the arrangement as ‘no more than a blank cheque for whichever private firm is most ruthlessly willing to cut costs to shore up their own profits’.

 

And if the ‘prime provider’ company does fail the tests they have created for themselves, there does not appear to be any provision for a break clause for the NHS to get out of the contract. OurNHS understands that - on the basis of what is set out here - it would be legally very difficult if not impossible for the ‘prime provider’ to be sacked for failings which they could blame on their sub-contractors. 

The shortlisted 'prime provider' bidders are all both controversial and well connected. They include United Health (through its subsidiary Optum), the former employer of new NHS boss Simon Stevens; Virgin Care (who have been warned about service standards by inspectors), CSC Computer Sciences (who were paid £12bn by the UK taxpayer for an IT project that failed to deliver anything that worked) and Interserve Investments (chaired by former Conservative policy chief Lord Blackwell).

Two NHS trusts are also shortlisted, those that currently run respectively Stafford and Stoke University Hospitals, and Wolverhampton hospital. But Godfrey has been advised that “this contract seems to have been designed expressly to exclude them” through clauses about financial arrangements “which seem to have been specifically written with a private company in mind”. There are also extensive clauses setting out competition requirements which appear to weigh most heavily on “current providers” (ie the NHS).  This might explain why, when Valerie Vaz MP asked local health boss Andrew Donald (chair of Stafford CCG) “Just tell me, is the University hospital happy with this process?” he replied simply “No, the chief executive is not.”

.........

What happens to the radiology department who are dealing with both cancer and non-cancer patients? What happens to the cancer patient who is being treated by the NHS for other conditions such as diabetes? What happens to patients who live on the geographical margins of the area? Does the contract even cover all patients in the area? To what extent will existing services be provided? What standards are expected to be met?

It seems these are treated as minor details to be worked out - after the £700m contract is awarded.

 

Nurses back calls to suspend NHS closures

RCN London wants guarantees about investment in out of hospital care

The Royal College of Nursing in London has backed calls for the suspension of further hospital closures in West London, find until guarantees can be given about investment in out of hospital care.

This message was part of the RCN London's response  to a major review led by Michael Mansfield QC into the Shaping a Healthier Future programme of hospital reorganisations in North West London.

You can read the RCN London's full response to the review online here.

The RCN says it has become increasingly clear that the promised investment in out of hospital care to make up for local A&E closures has not been delivered on the scale needed to keep patients safe.

This winter the remaining A&E units in the area have experienced some of the longest waiting times in the country.

The impact of the programme for patients is now being reviewed by Michael Mansfield on behalf of Brent, patient Ealing, cialis Hammersmith & Fulham and Hounslow Councils under the name “The North West London Health Commission”.

RCN London invited members working locally to contribute and among the problems raised by local nursing staff were:

  • Increased waits for ambulances outside hospitals and dangerous diversions due to capacity problems

  • A perceived lack of understanding by patients about the status of the new units. One member said “patients and particularly their carers are frightened and confused about the A&E service closures.”

  • Pressure on GP services, damaging the ability of practice nurses to carry out preventative health interventions – a clear driver over time of the increase in sick people presenting to A&E who should have been kept well earlier in the system.

  • An “unsafe and unmanageable” strain on district nursing staff.

  • Difficulty in transferring patients between services which have been differently arranged, creating delays for living donors and mental health patients

  • Registered nurses “burnt out, tired and frequently unable to get their time for the study days”, jeopardising continuing learning

RCN London Regional Director Bernell Bussue says: ' The RCN will always support service reorganisation which delivers improvements in the quality of patient care. However it is just not clear that patients have seen any benefit from these changes so far.

' The positive case for the Shaping a Healthier Future programme was based on an increase in out of hospital care to enable more patients to be kept well or treated at home to reduce hospital admissions. In practice, little seems to have been done to boost capacity elsewhere in the system to make up for the closures. Proper replacement services, transition arrangements, funding and a workforce plan should have been in place before the existing units were cut.

' Nursing staff working in the area have told us the closures have damaged patient care. The remainder of the Shaping a Healthier Future closures should be suspended until out of hospital capacity is properly expanded.'

For further information about the work of RCN London visit the website.

Hammersmith MP Andy Slaughter, who has been fighting the closure of A&E departments at Charing Cross and Hammersmith Hospitals says: ' This significant statement from one of the leading clinicians’ bodies should make the local NHS and Jeremy Hunt think twice about pushing ahead with further cuts and closures to healthcare services in west London.'

January 30, 2015